User’s News is a targeted harm reduction resource for people who use illicit drugs.

Jul 2 INSIDER OUTSIDER

I never planned on becoming a health bureaucrat. I never planned on becoming a “junkie” either for that matter. Both just happened because of time, place and circumstance. There were many similarities in both careers: for the time that I was one or the other, it defined my life. How and where I spent my days, who I spent my time with, my economic circumstances and my priorities. They both put limits on what I shared about my life and with whom.

They didn’t overlap. My drug using career ended a few years before we started hearing about HIV, although it was already around. I never planned a career in industrial relations either, but that’s where I was when HIV seemingly came from nowhere, a tide that rose and began to engulf everything. As volunteers, paid workers, bystanders, that tide slowly took many of us along. It killed many. It demanded a lot and I was woefully unprepared and unskilled for what was coming.

But worse, I soon realised that most of the people I met because they had careers in the area of drugs research, treatment or policy knew almost nothing about drugs, drug use, dependence, my life. There were a few exceptions, mostly other users who were doing what I was doing, one way or another. We were bonded by silence. The word community had a lot of currency in those days but there was no consensus as to what it meant. Members of a besieged community share a language, knowledge, understanding and wariness of those who marginalize and discriminate against us. No one asked but it wasn’t hard to sort out who you could trust.

Using what I did know could be dangerous. Early on there was a complaint made because I made the ‘counter intuitive’ suggestion that there was such a thing as a functioning drug user. I hadn’t been one of those people, but I knew plenty of them and they needed to know about the dangers of HIV – they were part of the user community we needed to reach, and we needed to reach them fast.

Many health policymakers and researchers didn’t want to countenance the idea, it didn’t fit with their neat them/us construction of the world. So as in war, one of the early victims of HIV was the truth — we didn’t ask why if we found a colleague was HIV positive as sometimes the way you became positive was best left unsaid.

So long as I stayed in Sydney, there was a community of users that I worked with and for, each in our own way, but together somehow. Leaving Sydney and the support it offered seemed a logical and ‘right’ thing to do at the time but it came with an unexpected cost. Away from Australia there was no supportive community to work within. I missed having users to talk to; people I felt could actually understand something of the gap between the dominant narrative we lived with and our reality. That became even worse when I started working for an international agency. To talk about my personal experience was seriously not going to help in the discussions I had with health and public security bureaucrats and politicians.

In public policy the idea of ‘community’ and the benefits it brought to prevention, treatment and care work was virtually unknown and the novel idea that users were people wasn’t even on the horizon. Harm reduction, forget it. ‘AIDS and drug use — these are two problems which will solve each other’ was a statement made at an international conference in 1991. Sharing my personal history would not have helped then or later. But that knowledge and experience still went into what I did.

I was working in Ho Chi Minh City In 1994 where HIV prevalence among users in the local ‘treatment centre’ was already over 52% and people with HIV were being put into broom closets in the local hospital to die. There were groups of users and their friends trying to do something for themselves about HIV, about drug dependence treatment, about denial of the most basic services, about the stigma, discrimination, harassment, persecution and summary execution that were the lot of users in many South East Asian countries. People who used drugs, sex workers, ‘young men’ and social work students were working night and day in Ho Chi Minh City to educate and support the people the city tried to forget. They may have been there before but certainly the growing response to HIV/AIDS gave them visibility and a legitimacy that did not exist beforehand.

Drug users marched through Cebu in the Philippines on World AIDS Day 2005 to make their presence, their plight and their needs known. Many did not welcome their presence. When the Lord Mayor of a nearby city is publicly praising masked vigilantes for killing drug users — those marchers in Cebu, those volunteers in Ho Chi Minh City — they were the real heroes of our time. Many of them are still fighting for the most basic rights. In this new era of ‘treatment is prevention’, I wonder what chance these communities have of seeing the benefit.

When did I eventually start talking about my career as a person who used drugs? Years later, near the end of my working life when I finally needed hepatitis C treatment. I told the boss whose only comment was “I did not know that!” He knew I was gay, that is something that he saw as a plus for the job. There is some irony there: being gay was cover. But I like to think he was fortunate in getting a two for one deal.